带拇趾末节趾骨及第二足趾皮岛再造拇指的临床研究

Thumb reconstruction using wrap-around flap from the big toe with the distal phalanx and the sMn island of the second toe： a clinical study

目的探讨带躅趾末节趾骨及第二足趾皮岛的改良全形再造在拇指Ⅱ类B区缺损再造中的临床效果。方法对6例外伤性拇指Ⅱ类B区缺损的患者，采用带躅趾末节趾骨及第二足趾皮岛的改良全形再造术，用同一血管蒂带躅趾末节趾骨的躅甲皮瓣及第二足趾中、近节骨和肌腱复合组织皮瓣再造拇指。结果术后6例再造拇指全部存活，随访时间6～24个月，再造拇指及供区蹰趾外形满意，按中华医学会手外科学会上肢部分功能评定试用标准进行手功能评定：优4例，良2例。患者生活均能自理，术后5例恢复工作。结论带躅趾末节趾骨及第二足趾皮岛的改良全形再造Ⅱ类B区缺损拇指最大程度地恢复了再造拇指特别是末节指体的良好外观及感觉，同时提高了再造指骨愈合率，恢复了再造拇指的活动功能，且对足部供区的功能影响有限。

Objective To evaluate the effect of modified full thumb reconstruction using wrap-around flap from the big toe alone with its distal phalanx and the skin island of the second toe for type ]I B thumb defect. Methods We applied a wrap-around flap including the distal phalanx from the great toe with the second toe dements including bones, tendons and skin to form a composite flap based on the same vascular pedicle for thumb reconstruction in 6 cases of type 11 B thumb defect. Results All of the 6 thumbs survived completely. Postoperative follow-up period ranged from 6 to 24 months. All the reconstructed thumbs and donor big toes had satisfactory appearances. According to the functional assessment criteria of the upper limb formulated by the Hand Surgery Society of Chinese Medical Association, the outcomes were graded as excellent in 4 cases and good in 2 cases. All the patients could manage their activities of daily living independently. Five patients returned to work. Conclusion Modified full reconstruction using wrap-around flap from the big toe alone with its distal phalanx and the skin island from the second toe for type 11 B thumb defect can not only restore the realistic configuration and sensation of the thumb, especially of the distal segment, but also enhance bone healing and recover the range of motion of the thumb. Donor site morbidity is acceptable.